Diuretics And Hypokalaemia : Aldosterone Antagonists Or Potassium Supplementation ?

ABSTRACT: The primary hyperaldosteronism, an endocrine disease increasingly identified in cats, is characterized by adrenal gland dysfunction that interferes with the renin-angiotensin-aldosterone system, triggering the hypersecretion of aldosterone. Pathophysiological consequences of excessive aldosterone secretion are related to increased sodium and water retention, and increased excretion of potassium, which induce hypertension and severe hypokalemia, respectively. The most common clinical findings in cats include: polydipsia, nocturia, polyuria, generalized weakness, neck ventroflexion, syncope, anorexia, weight loss, pendulous abdomen and blindness. Diagnosis is based on the evidence of hormonal hypersecretion with suppression of renin release, imaging and histopathological evaluation of adrenal glands. Treatment may be curative with adrenalectomy, in cases of unilateral disease, or conservative, through administration of aldosterone antagonists, potassium supplementation and antihypertensives. Prognosis varies from fair to good with the appropriate therapy. This article reviews the main aspects of primary aldosteronism in cats, providing the clinician with important information for the diagnosis of this disease.

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Aldosterone Antagonists Underused in Heart Failure

Family Practice News ◽

10.1016/s0300-7073(12)70723-5 ◽

2012 ◽

Vol 42 (18) ◽

pp. 7

Author(s):

SUSAN LONDON

Keyword(s):

Heart Failure ◽

Aldosterone Antagonists

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Faculty Opinions recommendation of Aldosterone antagonists for preventing the progression of chronic kidney disease.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718369600.793495490 ◽

2014 ◽

Author(s):

Luis Ruilope ◽

Enrique Morales

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Aldosterone Antagonists

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Faculty Opinions recommendation of Impact of Aldosterone Antagonists on Sudden Cardiac Death Prevention in Heart Failure and Post-Myocardial Infarction Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726155351.793515453 ◽

2016 ◽

Author(s):

Luis Ruilope ◽

Enrique Morales

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Systematic Review ◽

Sudden Cardiac Death ◽

Randomized Controlled Trials ◽

Cardiac Death ◽

Meta Analysis ◽

Controlled Trials ◽

Aldosterone Antagonists ◽

Randomized Controlled

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Diabetic Ketoacidosis Management and Treatment Outcome at Medical Ward of Shashemene Referral Hospital, Ethiopia: A Retrospective Study

Clinical Medicine Insights Endocrinology and Diabetes ◽

10.1177/11795514211004957 ◽

2021 ◽

Vol 14 ◽

pp. 117955142110049

Author(s):

Getu Melesie Taye ◽

Amente Jorise Bacha ◽

Fetene Abeje Taye ◽

Mohammed Hussen Bule ◽

Gosaye Mekonen Tefera

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Treatment Outcome ◽

Hospital Mortality ◽

Medical Ward ◽

Inclusion Criteria ◽

Potassium Supplementation ◽

Poor Treatment ◽

Poor Treatment Outcome ◽

Concurrent Medication

Background: Diabetic Ketoacidosis (DKA) is the most common and yet potentially life-threatening acute complication of diabetes that progresses rapidly to death and requires immediate medical intervention. Objective: To assess the DKA management and treatment outcome/in-hospital mortality and its predictors among hospitalized patients with DKA at the Medical ward of Shashemene Referral Hospital (SRH). Method: A retrospective study was conducted at the Medical Ward of SRH from 01 February 2015 to 31 January 2017. A systematic random sampling technique was used to select study subjects based on the inclusion criteria. Thus, of 236 reviewed charts, only 225 patients with DKA fulfilled inclusion criteria. Treatment outcome was considered good for patients who have shown improvement at discharge, while poor for patients who left against medical advice or died in the hospital. Logistic regression analysis was done to determine independent predictors for treatment outcome/in-hospital mortality using SPSS version 20 with statistical significant at P ⩽ .05. Results: Of 225 patients with DKA, 124 (55.1%) were male. Regular insulin was prescribed to all patients and antibiotics were administered to 87 (38.7%). Potassium supplementation was given only for 28 (12.4%). Non-adherence to insulin treatment (n = 91; 40.4%) and infection (n = 66; 29.3%) were the principal DKA precipitating factors. Even though 73.8% of hospitalized patients with DKA have shown good treatment outcomes, DKA contributed 12% in-hospital mortality. The result of multivariate logistic regression analysis shown that hypoglycemia is the only independent predictor for in-hospital mortality[ P = .03]. Moreover, the independent predictors for poor DKA treatment outcome were found to be smoker [ P = .04], Urinary tract infection (UTI) relative to other co-morbid condition [ P < .001], severe hypokalemia which increase risk of poor treatment outcome by around 4 times [ P = .02], and use of Metronidazole as a concurrent medication relative to other concurrent medication [ P = .03]. Conclusion: There was a high in-hospital mortality rate due to correctable causes. This mortality is unacceptable as it was majorly related to the poor practice of potassium supplementation and hypoglycemia due to insulin. Thus, clinicians and stakeholders should have to focus on modifiable factors (hypokalemia, UTI, and hypoglycemia) to reduce poor treatment outcome/in-hospital mortality.

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MICRONUTRIENT CONTENTS IN THE PROFILE OF A RECOVERED SOIL WITH SEWAGE SLUDGE AND NATIVE SPECIES OF ATLANTIC FOREST

FLORESTA ◽

10.5380/rf.v49i3.59351 ◽

2019 ◽

Vol 49 (3) ◽

pp. 485

Author(s):

Lívia Mara Lima Goulart ◽

Marianne Fidalgo de Faria ◽

Grasiela Spada ◽

Thiago Tássio de Souza Silva ◽

Iraê Amaral Guerrini

Keyword(s):

Sewage Sludge ◽

Atlantic Forest ◽

Soil Profile ◽

Native Species ◽

Control Treatment ◽

Mineral Fertilization ◽

Promising Alternative ◽

Final Destination ◽

Potassium Supplementation

The use of sewage sludge in agriculture and recovery of degraded areas has been shown as a promising alternative for its final destination. Studies on micronutrient levels after sludge application are necessary to avoid soil contamination at toxic levels. The objective of this work was to verify the micronutrient contents in the soil profile and pH, up to one-meter-deep, nine years after the application of sewage sludge and planting of native species of the Atlantic Forest. The experiment was implemented in a degraded Quartzeneic Neosol and conducted in randomized blocks with four replicates and eight treatments, consisting of six doses of sewage sludge (0, 2.5, 5, 10, 15 and 20 Mg ha-1, with supplementation of potassium due to low concentration in the residue), besides the control treatment, mineral fertilization and only potassium supplementation. After nine years, the contents of all micronutrients evaluated presented a significant response to the application of the treatments, and the application of sewage sludge provided an increase in their contents. Soil pH remained stable at sites receiving mineral fertilization and potassium supplementation. Only manganese and zinc showed mobility in the soil profile. The application of sewage sludge in degraded soil increases the micronutrient content and decreases its movement in the soil profile, and the application of the maximum dose of the residue does not provide toxic levels of these elements in the soil in the long term.

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